Emergency dermatology

Question 1

Features/consequences of skin failure

Answer 1

Fluid/electrolyte disturbance

Temperature dysregulation

High risk of infection/sepsis

Haemodynamic instability - high-output CF

Oedema, hypoalbuminaemia

Question 2

Features of erythroderma

Answer 2

Inflammatory skin condition (exfoliative dermatitis) affecting >90% of body area

Bright red, hot

Scaly, thickened skin

systemically unwell

Question 3

Causes of erythroderma

Answer 3

Idiopathic

Drugs

Dermatitis/eczema

Psoriasis

Cutaneous lymphoma

Question 4

Management of erythroderma

Answer 4

Supportive: obs, fluid balance, nutrition

treat infx

Withdraw offending drug

Emollients and soap substitutes

Consider systemic steroids

Question 5

Prodrome of SJS/TEN

Answer 5

1-14d flu-like illness

skin tenderness/burning

conjunctival burning

2-6w latency following drug ingestion possible

Question 6

Presentation of SJS/TEN

Answer 6

Early: Target lesions/diffuse erythema

Late: Sheet-like epidermal loss, Nikolsky’s sign (rubbing = sloughing), flaccid blisters

Question 7

Causative agents SJS/TEN - drugs

Answer 7

Drugs:

Sulphur-based (sulphasalazine, sulphonamides)

NSAIDs

Allopurinol

Penicillins, quinolones, vancomycin

Anticonvulsants

Question 8

Difference between SJS and TEN

Answer 8

SJS <10%

TEN >30%

Question 9

Management of SJS/TEN

Answer 9

Specialist unit (HDU/ITU/Burns)

Analgesia

Withdraw causative med, treat sepsis

Fluid/electrolyte support

Ophtho referral

Question 10

Causative agents SJS/TEN - infection

Answer 10

Yersinia

EBV

Adenovirus

Coxsackie

Histoplasma

Mycoplasma

Question 11

Features of erythema multiforme

Answer 11

Bilateral, symmetrical

Target lesions

No mucosal - minor

1 mucosal - major

2 mucosal - SJS

Question 12

Causes of erythema multiforme

Answer 12

50% idiopathic

HepB, HSV, mycoplasma common ppt

<10% drugs - phenytoin, allopurinol, sulphonamides, penicillin

Question 13

Features of eczema herpeticum

Answer 13

Widespread eruption of painful, crusted/punched out vesicles

Hx of eczema

Systemically unwell

Question 14

Management of eczema herpeticum

Answer 14

Topical emollients

viral swab

IV/oral acyclovir

IV flucloxacillin to prevent 2ry bacterial infx

Delayed (48h) topical steroid

Same-day ophtho review

Question 15

Features of urticaria

Answer 15

Wheals last <24h - migratory nature

Very itchy

Treated with antihistamines

Consider early sign of allergy/anaphylaxis

concern if 2 Ds: dizziness, difficulty breathing

Question 16

Subtypes of urticaria

Answer 16

Idiopathic

Cold/heat

Allergic

Cholinergic (sweat-related)

Question 17

Differential for purpuric eruption

Answer 17

Meningococcal septicaemia- Hx of meningitis

Vasculitis - painful lesions, dependent areas, must do urine dip

Senile purpura - non-palpable, extensor surfaces of elderly

DIC - liver failure, trauma, sepsis, malignancy, obstetric complications